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Scapular Dyskinesia and its
Relationship to Rotator Cuff
Impingement Syndrome
Nadir Mawji
MSc PT Student Year 2
May 16, 2013

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Scapulohumeral Rhythm

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Why Supraspinatus?

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Rotator Cuff Impingement
Treatment Best Practice
 Key messages from Kuhn, 2009:
 Exercise is effective as a treatment to reduce pain
 Exercise + manual therapy = best outcomes
 The literature is not clear on which exercises are best, but must be
addressed to individual patient needs (clinical reasoning)

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Impingement Syndrome Exercises
(Kuhn, 2009)

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Impingement Syndrome Exercises
(Kuhn, 2009)

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What is Scapular Dyskinesia?
 “Alteration in the normal static or dynamic position or motion of
the scapula during coupled scapulohumeral movements.”
(Sevinsky, S)
 Alters the scapulohumeral rhythm
 Scapular dyskinesis identified in (Warner, 1992):
 68% of RC problems
 100% of GH instability

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Less Common Causes of Scapular
Dyskinesia
 Bony
 thoracic kyphosis, clavicular # (non-union), shortened clavicular
malunion
 Joint
 High grade AC instability, AC arthrosis/instability, GH jt internal
derangement
 Neurologic
 Cervical radiculopathy, nerve palsy (long thoracic n, spinal acc n)
(Kibler, 2012)

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19. +Common Causes of Scapular Dyskinesia
1. Shortening of pec
minor, short head of biceps
brachii
 Result in anterior tilt +
protraction of scapula
2. GH IR deficit
Creates “windup” of
scapula on thorax with arm
in IR or ABD
(Kibler, 2012)

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3. Poor Patterning
-Serratus activation/strength
-loss of posterior
tilt/upward rotation
-Altered UFT/LFT Force couple
-delayed onset of LFT
alters upward rotation and
reduces posterior tilt
(Kibler, 2012)
Common Causes of Scapular
Dyskinesia

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Identification of Scapular Dyskinesia
Observation: SICK posture (Burkhart, 2003)
 Scapular malposition
 Inferior medial border prominence
 Coracoid pain and malposition
 Dyskinesis of scapular movement

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Clinical Examination Findings
Dynamic Examination of Flexion/Abd
-Pt holds 3-5 lb weight
-observe repeated flexion/abd 4-
5 times
-prominence of medial border
suggestive of scapular
dyskinesia
sensitivity, 78% [flexion]
74% [scaption]
positive predictive
value, 76% [flexion]
78% [scaption]
(Kibler, 2003)

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Scapular Assistance Test
 Used in evaluating scapular contributions to impingement and
RC strength

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Test Time!

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Inferior Glide Exercise (LFT)

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Low Row (LFT)

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Push “Plus” (Serr Ant)

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Lawn Mower (LFT progression)

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Robbery (LFT Progression)

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Summary
 Determine if scapular dyskinesia is present
 Observe for SICK scapula
 Dynamic testing (look for prominent inferior/medial border)
 Apply corrective movement and assess for change
 If Scapular dyskinesia is present
 Address underlying dysfunction
 Stretch short pec minor/short head of biceps
 Manual therapy to reduce GH IR deficit
 LFT/Serr strengthening for poor patterning

31. (Kibler, 2003)

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References
1. Kibler WB, Sciascia AD, Uhl TL, Tambay N, Cunningham T. Electromyographic Analysis of
Specific Exercises for Scapular Control in Early Phases of Shoulder Rehabilitation. Am J Sports Med.
2008 Sep 1;36(9):1789–98.
2. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a
synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009 Feb;18(1):138–60.
3. Tyler TF, Nicholas SJ, Roy T, Gleim GW. Quantification of posterior capsule tightness and motion
loss in patients with shoulder impingement. The American journal of sports medicine. 2000;28(5):668–
73.
4. Kibler WB, Sciascia A, Wilkes T. Scapular dyskinesis and its relation to shoulder injury. Journal of
the American Academy of Orthopaedic Surgeons. 2012;20(6):364–72.
5. Kibler WB, McMullen J. Scapular dyskinesis and its relation to shoulder pain. J Am Acad Orthop
Surg. 2003 Apr;11(2):142–51.
6. Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R. Scapulothoracic motion in normal
shoulders and shoulders with glenohumeral instability and impingement syndrome A study using Moire
topographic analysis. Clinical orthopaedics and related research. 1992;285:191–9.
7. Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology Part
III: The SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy.
2003;19(6):641–61.
8. Parsons IM, Apreleva M, Fu FH, Woo SLY. The effect of rotator cuff tears on reaction forces at
the glenohumeral joint. J. Orthop. Res. 2002 May;20(3):439–46.
9. Kibler WB. The role of the scapula in athletic shoulder function. The American Journal of Sports
Medicine. 1998;26(2):325–37.